Running head: NURSING PERSPECTIVE ON HOSPICE

A Nursing Perspective on Hospice Care

Maggie M. Fabry
California State University Stanislaus

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A Nursing Perspective on Hospice Care

Spending a day in a hospice setting is an amazing opportunity for a future nurse.
Death and dying are processes that every nurse will likely encounter during their career.
For this reason, it is good to face any fears or hesitations related to these processes by
experiencing a day in the life of a hospice nurse who deals with death and dying each and
every shift. Through gaining knowledge of the hospice process, nurses are also in a
better position to give clients guidance, information, and referrals to hospice care
facilities as necessary.
Palliative and hospice care have many similar characteristics, but have well
defined differences as well. Many of the similarities between the two types of care
involve the goals and interventions seen in both environments. Both palliative and
hospice care settings focus heavily on managing pain and the other symptoms associated
with the particular disease process (Batchelor, 2010). In addition, both offer a support
system for loved ones and friends of the client. Also, neither hospice nor palliative care
aim to hasten death or postpone death. In fact, hospice care is associated with longer
survival rates when implemented in a timely manner and with certain diagnoses (Rogers,
2009). Lastly, both types of care use interdisciplinary techniques in managing the care of
the patients.
The differences between hospice and palliative care mostly relate to the stage in
the clients disease process in which they become eligible for care. Hospice care is
comprehensive care given to individuals who are near end-of-life stages of their illnesses
(Batchelor, 2010). In order to receive hospice care, two physicians must certify that an
individual is expected to live for six months or less. Palliative care was an advancement

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of hospice developed so that individuals with chronic illness could receive caremanagement earlier on in their disease processes. In order to receive palliative care, am
individual does not have to be in the terminal stages of their illness. In fact, the
individual does not have to have a terminal illness, and palliative care can be used in
elderly who experience disability and general discomfort (Batchelor, 2010).
Through observing the hospice care setting for a day, evidence of care dealing
with physical well- being was a focus area. Many patients received around-the-clock
pain medications such as Methadone, Morphine and Dilaudid. For many of the
unresponsive patients, sublingual doses of these opioids were given. In addition to pain
management, individuals were frequently repositioned so that a position of comfort could
be obtained. Liquids and/or mouth rinses were given to relieve dry mucous membranes
in the oral cavity. Clients were asked frequently about the presence of pain, and those
who were unresponsive were given pain medications based on how painful their
particular disease process is generally known to be.
The psychological well-being of clients was also addressed in the hospice setting.
The chaplain was a great resource for this. He would go from room to room and ask
patients if they would like to talk or to hear a song. He brought a guitar with him and
played softly for those who wanted to hear music. In addition, anti-psychotics were
given to many patients experiencing hallucinations like many due who are nearing the
end of their life. Medications to assist with sleep and anxiety were also administered
regularly to help the patients to be able to relax.
The social-well being of patients is also encouraged in many different ways.
Firstly, friends and family members are encouraged to join the clients at any and all times

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during their stay in the hospice house. There are even fold out couches for family
members that wish to stay the night with their loved ones. For those patients who do not
have friends and family that are available to see them, there is a volunteer program that
was designed for just this purpose. Volunteers go from room to room and provide social
interaction and companionship for clients. Many times, the volunteers simply sit next to
the patients, just to let them know that they are not alone. Volunteers can read and sing
to the patient, and can do activities with patients that are more active.
The spiritual well-being of clients was also a focus area in the hospice setting.
The chaplain was also an amazing resource in this area. The chaplain sees each patient at
least once per day unless a patient has specifically asked not to see him. The chaplain
brings a bible and a guitar each time he enters the patients room. However, the chaplain
focuses less on religion and more so on spirituality, and will discuss any spiritual matter
that a client desires. The chaplain also offers spiritual support for family and friends of
the patient. In addition, there is a chapel in the hospice house that clients and family
members can utilize at any time.
The role of the nurse in providing end-of-life care was different than expected.
Each shift, only two registered nurses (RN)s were present to oversee all patient care.
RNs perform head-to-toe assessments every shift for newly admitted patients and those
facing imminent death and each week for those patients who are stable. Registered
nurses also administer all client medications. In addition to the RNs, hospice care
workers who are similar to certified nurse assistants provide many other services such as
repositioning, feeding, bathing and companionship.

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This was an amazing experience. Through spending this day in the hospice
setting, one feels better prepared to deal with end-of-life matters. Observing the role of
the nurse and the interdisciplinary approach of care provided in this setting is inspiring
and will lead to more patient referrals to hospice sooner than later in their terminal
process. The most important thing learned from this experience is the amazing support
that a chaplain can provide to patients and their families. The chaplain in the hospice
house was such an amazing resource for patients, and knew how to get patients to talk
about things that were plaguing them when no one else could. It was remarkable to
witness the chaplain performing his duties.

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Resources
Batchelor, N. H. (2010). Palliative or hospice care? Understanding the similarities and
differences. Rehabilitation Nursing, 35(2), 60-64. Retrieved from
http://onlinelibrary.wiley.com.ezproxy.lib.csustan.edu:2048/store/10.1002/j.20487940.2010.tb00032.x/asset/j.2048-7940.2010.tb00032.x.pdf?v=1&t=i1ww4xvz
&s= 4c9f3da265f4a094c0314c06e43d56441ca16d30
Rogers, T. (2009). Hospice myths: What is hospice really about? Pennsylvania Nurse, 47. Retrieved from http://web.b.ebscohost.com.ezproxy.lib.csustan.edu:2048/eho
st/pdfviewer/pdfviewer?sid=275791b9-5191-43fe-8b35-144567615edc%40sessi
onmgr198&vid=5&hid=125